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the Census; and because they are professionals they acceptthe blame for the wrong answers that their survey revealed.It is less easy for doctors, trained in other disciplines, torealise that even what appears to be a sensible questionmay yield a misleading answer.

TUBERCULOSIS IN HONG KONG

THE eradication of tuberculosis throughout the worldis now medically possible. But the emergence of moreand more tubercle bacilli resistant to the older anti-tuberculous drugs makes the clinical trial of new drugsof continuing importance. It is not now justifiable totreat any patient with active tuberculosis by a single drug,so trials of new drugs must be carried out by comparativemethods. An important comparison recently reported 1

by Citron is that carried out by the research committeeof the British Tuberculosis Association and the tuberculosisservices in Hong Kong.Treatment with ethionamide and isoniazid was com-

pared with treatment with p-aminosalicylic acid andisoniazid. 136 tuberculosis patients in Hong Kong weretreated daily with either 500 mg. of ethionamide and 300 mg.of isoniazid or 12 g. of p-aminosalicylic acid and 300 mg.of isoniazid. All had sputum cultures initially sensitiveto the drugs being given. The two groups were similarin age, sex, and bacteriological condition. The ethion-amide group had slightly more cavitation. After twenty-eight weeks’ treatment, 810 of the group receivingethionamide and isoniazid and 87 °o of the groupreceiving p-aminosalicylic acid and isoniazid were

sputum-negative. At fifty-two weeks the respectivefigures were 85",, and 87%. These are percentages ofthe number initially accepted for treatment and thereforetake count of those patients withdrawn for reasons suchas drug resistance or toxicity as well as for treatmentfailure. In fact both drug regimens were well tolerated,and differences in the two as regards radiographicimprovement and weight gain were not great. After one

year’s treatment 92",, of all the 149 patients who hadstarted treatment were sputum-negative on culture.The conclusion is that 500 mg. of ethionamide and

300 mg. of isoniazid given in a single daily dose arehighly effective in the treatment of newly diagnosedpulmonary tuberculosis in which cultures are sensitive tothese drugs.

ANÆSTHETIC-ROOMS

THE role of the ansesthetic-room and its architecturalfeatures were discussed at a meeting on Jan. 27 at theHospital Centre in London, attended by anxsthetists,architects, administrators, and others concerned in the

hospital rebuilding programme. The policy of the

Ministry of Health to provide an anxsthetic-room forevery operating-room must be carried out if the needs ofpatients and anxsthetists are to be met and the risk ofcross-infection is to be curtailed.

The most important requirement for the patient inthese days of light premedication is a quiet room, wherethe atmosphere is not too clinical, and the lighting is subduedexcept at certain focal points. A straight trolley-run fromentrance to operating-room is advisable, but the roommust not be regarded as the natural entrance to the

operating-room for all and sundry. The anaesthetist

1 Tuberc, Lond. 1964, 45, 229.

needs a room where he is in control and in which there is

plenty of space to manoeuvre: figures of up to 290 sq. ft.are now being recommended. Local storage of equipmentsuits British methods far better than the American" cart system " and central storage. A case was madefor performing all preliminaries to the operation in theanaesthetic-room, to ensure the least possible disturbanceof the atmosphere in the operating-room. The meetingemphasised the need to break away from the traditionalutilitarian decor.

VIRAL INHIBITION OF MOUSE LEUKÆMIA

Molomut et al.1 reports a virus active against a trans-plantable mouse lymphoid leukaemia and Ehrlich’s ascitescarcinoma, thus adding another to the list of oncolyticviruses. Apart from the intrinsic interest in these agents,there is always the hope that they may be useful in thetreatment of malignancy.The unidentified virus described by Molomut et al.

has a lymphocytopenic action in vivo. It was isolated froma non-tumour-producing line of Ehrlich’s ascites carcinomamaintained in tissue culture. When inoculated into adultmice it initiates an acute infection in 7-10 days, withreduction of lymphocytes in lymph-nodes, thymus, andspleen. There is also some fatty degeneration of the liverand a slight ascites. When a lymphoid leukxmia, originallyinduced by treating mice with the carcinogen 3,4,9,10-dibenzpyrene, is transplanted into normal mice, it causesdeath of the host in 7-12 days, according to the numberof leukaemic cells introduced. Molomut et al. infectedmice with a standard dose of lymphocytopenic virus atthe time they implanted leukaemic cells. Control animals

given 500 cells were all dead in 12 days: half the animalsgiven 500 cells plus virus survived; and in the other groups,given virus and larger numbers of cells (up to 5 million),the median survival-time was longer, by a third or more,than in controls given leukaemic cells only. Mice givenvirus and Ehrlich’s ascites carcinoma cells also had a

longer survival-time as well as some complete remissions.Mice which had recovered from infection by the lympho-cytopenic virus were immune to a second infection but fullysusceptible to the lymphoid leukaemia.

Experimental work, much of it undertaken by Loveand his collaborators, has shown that such diverse virusesas Newcastle disease, Coxsackie B3, and several of thearthropod-borne viruses can be so adapted, by serial

passage through the appropriate tumour, that they becomestrongly oncolytic. Clearly, however, many factors mustbe considered before embarking on treatment of cancerby selective infection with viruses. The patient should, ofcourse, not be put in hazard by the virus infection; norshould the possible efficacy of other methods of treatmentbe jeopardised. Tests of virus therapy have, reasonably,been confined to patients with advanced and even inoper-able cancer. The chance of a cure may be better if thenumber of malignant cells to be destroyed is not enor-

mously large. During many replication cycles in a tumourmass it is not improbable that virus and malignant cellsmay become so adapted as to abolish the destructive

potential of the virus, with the establishment of either achronic or a latent infection. Such infections have beeninduced experimentally in cell cultures by balancing virusagainst antibody and interferon. Although antibody hasto be introduced into the experimental system, we must, in

1. Molomut, N., Padnos, M., Gross, L., Satory, V. Nature, Lond. 1964,204, 1003.

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the whole patient, expect the formation of antiviralantibodies as well as interferon

Disappointment is the likeliest outcome, but perhaps asystematic investigation should be undertaken byclinicians, virologists, and pathologists of the therapeuticinfection of cancers with known, identifiable viruses-evenif for the negative reason that we can then stop wonder-ing whether this will work. There is also the possibility 2that acute leukaemia may be influenced by virus inter-ference.

THE FIRST STEP?

AT the beginning of this week the Minister of Healthannounced that televised cigarette advertisements are to bebanned in this country.

Advertisements can do three things. They can inducean established consumer to transfer his loyalty from onebrand to another; they can persuade him to increase hisconsumption; and they can raise fresh recruits. It isunrealistic to pretend that an advertisement that will doone of these things will not also do the other two. We arenot concerned with the first of these three objectives-the only one that the advertisers readily admit. -Thesecond may be more important; let any non-smoker whodoubts this watch a company of smokers in front of atelevision set, and see them unconsciously light up insympathy with the actors on the screen. But the third isthe one that should concern us most. Advertisers mayprotest that the bronzed young gods and goddesses whoseason their manly pursuits, and their unending quest forhealth and fresh air, with deep draughts of some brand orother of smoke are only trying to show addicts how muchcheaper or tastier are their cigarettes than all others; butcan anyone seriously believe that they are not also

persuading youngsters that a cigarette is the properaccompaniment to other, more innocent pleasures ?The Minister of Health is already being attacked on the

ground that it is illogical for him to suppress advertising inone medium while he does nothing about all the others. Itis nothing of the kind. He has " discriminated " againsttelevision because this is the only form of advertising overwhich, so far, he has any statutory powers. In his state-ment to Parliament on Monday he hinted that he mightseek further powers. We can wish new legislation designedto strengthen his hand a safe passage.

THE NEED FOR MORE FOSTER PARENTS

THE Institute of Municipal Treasurers’ return on

children’s services 3 has once again focused attention onthe paradox that although care in foster-homes is cheaperthan care in local authority homes and is better for mostchildren, only half the children in the care of localauthorities are fostered out. Furthermore this national

average conceals wide variations between authorities. A

few, such as London County, have only one-third of itschildren in care in foster-homes.

’; The average cost of boarding-out a child in a foster-home is little more than E2 10s. a week, while the averagecost of keeping a child in a local-authority home is morethan 10 guineas a week. To some extent, these figuresoverstate the difference in costs because the figure for

rboarding-out excludes the cost of supervision which is by2. See Lancet, 1964, ii, 1163.3. Children Services Statistics, 1963-64. Institute of Municipal Treasurers

and Accountants, Buckingham Place, London, S.W.1. 1964. Pp.23. 5s.

no means negligible, since under Home Office regulationsfoster-homes must be investigated very carefully before achild is entrusted to them, and most children are visited bya child-care officer at leastonce every two months. Theyalso overstate the money that could be saved if many morechildren were in foster-homes, because many authoritiespay a great deal more than the average to foster-

parents who look after older, difficult, or handicappedchildren.

Nevertheless, the paradox remains. Why are only halfthe children boarded in foster-homes, and why is the pro-portion so low in some areas ? One reason is that it is notin the interests of some children to be sent to a foster-home. For instance, it is undesirable to part brothers andsisters, or to place them where their own parents cannotvisit them. Older boys and girls often have difficulties inadapting themselves to family life in a strange household,and are happier in a children’s home or boarding-schoolwhich makes fewer emotional demands on them and is less

likely to create loyalties which can conflict with those oftheir families. Some children may be difficult for foster-

parents to cope with, and it is better that they should livein even a mediocre children’s home which tolerates theirbehaviour than in a succession of foster-homes.A second reason is that some local authorities inherited

more than the usual amount of institutional accommoda-tion and their children’s officers may feel themselves underconsiderable pressure from committee members andfinance departments to keep the institutions filled.

But the most important reason is the difficulty in

recruiting foster-parents. Social conditions that create

great need for child-care services are often those that alsomake it most difficult to find good foster-homes. In someof the areas where a high proportion of women go out towork and where houses are old, small, lack amenities, andare overcrowded, a high proportion of children have dis-turbed backgrounds or are committed to care by theCourts. Such areas sometimes find it difficult to recruitand keep experienced child-care officers; and experiencedchild-care officers who get to know a district well are of

great value in recruiting foster-parents. There is an acutescarcity of child-care officers, and it seems likely to persistfor many years despite expanding programmes for train-ing. It is surely arguable that the Home Office should tryto control their distribution, in the same way as the

Ministry of Education tries to control the distribution ofteachers, so that the neediest authorities have a betterchance of getting an appropriate share.One obstacle to recruiting foster-parents that could be

removed is the pitifully small financial reward offered forthe care of what are often very difficult children. It hassometimes been argued that to pay foster-parents morethan the bare minimum would encourage the wrong typeof people to apply. Inevitably the supply of foster-parentsis limited because they must be mature people, capable ofgiving a difficult child affection without being over-

possessive, of encouraging him to keep contact with hisown parents, and of treating his feelings for his own familywith respect even when the natural parents seem to the

foster-parents to be irresponsible or unstable. Nor can

they expect to enjoy the same emotional rewards as a

family that adopts a child and thus has security for therelationship they create with it. Paying a bigger allowancecould only mean that more people would be interested inbecoming foster-parents, and child-care officers wouldhave a wider choice of homes for children.